This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Saturday, May 03, 2014

Weekly Overseas Health IT Links - 3rd May, 2014.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

Since the release of smartphones and the iPad, the healthcare industry has taken a keen interest in adopting portable computing for a clinical environment. And just as quickly as mobility has arrived, those form factors may have to make space for another new gadget, Google Glass.

Over the past two years, clinical staffs have been dipping their toes in the water with a handful of small experiments using Glass, and recent successes have led to a greater interest in the product as a viable medical tool. Not only are doctors and hospitals intrigued by the prospect of Glass, a number of startups have emerged with the goal of building healthcare-specific software to make the most of Google’s hi-tech headgear.

Google Glass—from search engine giant Google Inc.--comprises a pair of glasses equipped with a camera, microphone and small LCD display that connects to the user’s phone. Glass enables its users to record video and make gestural commands using the camera, as well as give voice commands over its built-in microphone, all while showing the user what they need through the display.

Nearly three-quarters of providers surveyed by Part B News aren’t letting the ICD-10 delay get them down. The majority of respondents are more or less keeping to the plans they set in order to be ready for the new codes by 2014, even though they will have at least one extra year to prepare due to the recently mandated extension of the timeline. While many of the 1100 providers cited financial outlay as one of their biggest concerns, average spending rates among the participants were far below the dire predictions made by the American Medical Association (AMA) earlier this year as they advocated for a pushback.

Among the most difficult obstacles encountered during the ICD-10 transition are documentation improvement (22%), staff reluctance to participate (19%), and a lack of testing opportunities (14%). Scarce resources also made the list of serious concerns, and the delay is only compounding the worries over keeping the momentum going through another twelve months of preparation.

With CIOs facing mounting pressures, the relationship with their core vendor is becoming increasingly critical. And although most are generally satisfied, they’re willing to make some noise — or even walk — if things go south, according to the April healthsystemCIO.com Snap Survey, which found that 69 percent of CIOs have a “very good” relationship with their core vendor, and 63 percent find their vendor to be “very responsive.”

But while most CIOs are getting what they need, it doesn’t always happen right away — or without a little nudging. “Much of the time, our core vendor is very responsive,” noted one respondent. However, “in some instances, we have to push hard or wait longer than we’d like to get attention or to get in touch with the right people there who can make things happen.”

Healthcare practices are increasingly partnering with trusted cloud service providers to provide enhanced data security along with improved efficiency of IT operations.

A growing number of healthcare practices are finding that cloud services, once feared by security-conscious providers, are now proving to be a safer option than on-premises alternatives.

While only 4% of healthcare providers adopted the cloud in 2011, use of the vertical cloud is now growing by 20% annually, according to MarketandMarkets. By 2017, the researchers predict, healthcare organizations will spend $5.4 billion on cloud services.

Compared to other industries, healthcare is particularly vulnerable to cyber attacks with the threats to health information continuing to mount as the industry moves to adopt electronic health records. Earlier this month, the FBI's Cyber Division issued a notice warning that healthcare systems and medical devices are at risk for increased cyber intrusions for financial gain.

"Cyber actors will likely increase cyber intrusions against healthcare systems--to include medical devices--due to mandatory transition from paper to electronic health records, lax cybersecurity standards, and a higher financial payout for medical records in the black market," according to the FBI. "The deadline to transition to EHR is January 2015, which will create an influx of new EHR coupled with more medical devices being connected to the Internet, generating a rich new environment for cyber criminals to exploit."

The government’s pledge to give patients online access to their GP records by March 2015 has been scaled back again, with practices now only required to have a plan to provide access by the deadline.

The Department of Health’s 2012 NHS information strategy said that all GP practices would be expected to provide electronic booking, cancelling of appointments, online prescriptions, electronic online access to their record to anyone who wants it by 2015.

Up to 500 GP practices will trial care.data in a phased roll out beginning this autumn, NHS England has announced.

In a letter to clinical commissioning groups and local area teams, NHS England’s director of patients and information, Tim Kelsey, says that the delayed roll out of the controversial programme, which will extract data from GP practices, will begin with a pilot.

“This will involve a cohort of between 100 and 500 GP practices to trial, test, evaluate and refine the collection process ahead of a national roll out,” he says.

Focus groups concentrated on a key Medicaid population--medically and socially complex, low-income patients--revealed areas for which connected health initiatives could bring improvements, according to a blog post at Health Affairs.

The focus group participants were receiving services from case management/care coordination programs in New York state or Philadelphia.

These patients often have multiple conditions, including substance abuse and mental health issues, and have unstable living conditions. Many lack permanent housing, are homeless or live in shelters.

The FBI has issued two warnings this month that healthcare organization systems, including medical devices, could be vulnerable to cyberattacks.

"The healthcare industry is not as resilient to cyber intrusions compared to the financial and retail sectors, therefore the possibility of increased cyber intrusions is likely," it said in a "private industry notice," or PIN, issued April 8.

Hospitals like Lucile Packard Children's Hospital are creating a professional pathway around clinical informatics

Things have been moving fast around the creation of a unique new subspecialty—clinical informatics. In 2011, the American Board of Medical Specialties (ABMS) approved clinical informatics as a clinical subspecialty, uniquely designed that physicians already boarded in virtually any specialty could sit for the clinical informatics examination.

The first examination was offered in the autumn of 2013, and also uniquely, the ABMS allowed for physicians to “grandfather” into the specialty via a practice pathway based on experience, or to qualify by earning a master’s degree program in the fi eld. That means that physicians already practicing as medical informaticists have until 2018 to grandfather in through experience and exam-taking.

For decades, the data OhioHealth staff collected resided in silos spread across its 10 hospitals and countless departments. Two years ago, the nonprofit healthcare organization began investing in data governance and an enterprise data warehouse to cleanse and safely store data so business users could access, analyze, and act on the critical information.

The advent of electronic health records (EHRs), e-prescriptions, accountable care organizations, and value-based payments that demand analysis of cost versus quality meant the family of eight hospitals and about 55 healthcare organizations could no longer continue treating data in this manner, said Dr. Mrunal Shah, a practicing physician and system VP for healthcare informatics at OhioHealth. It also meant the organization could not advance without a data warehouse -- a trusted, secure central repository for all information, he said in an interview.

The Food and Drug Administration is seeking public comment on a proposal to create a new program to provide earlier access to certain high-risk medical devices.

These are devices that are intended to treat or diagnose patients with serious conditions whose medical needs are not being met by current technology. However, some stakeholders are critical of the approach, labeling it as not new and benefiting only a handful of medical device companies.

Health information technology systems have made their way to the No. 1 patient safety concern for healthcare organizations, according to the findings of a new ECRI industry report.

The report, which includes data on more than 300,000 safety event reports, underscores healthcare's top 10 patient safety concerns for 2014 and puts data integrity failures with HIT systems at the very top.

"Health IT systems are very complex," said James P. Keller, vice president of technology evaluation and safety at the ECRI Institute, in the report. "They are managing a lot of information, and it's easy to get something wrong."

Meaningful Use: It's just like high school, where you learned all the right facts for the test, but the knowledge didn't stick with you any longer than until the end of the semester. At least, that's the opinion of Dale Sanders, former CIO of Cayman Islands Health Services Administration and current senior vice president for strategy at Health Cataylst, writing in a post at healthsystemCIO.com.

"... [L]ike a teacher who 'teaches to the test,' the program created a very complicated system that might pass the test of MU, but is not producing meaningful results for patients and clinicians," Sanders writes. "It's time to put an end to the federal MU program, eliminate the costly administrative overhead of MU, remove the government subsidies that also create perverse incentives, and let 'survival of the fittest' play a bigger part in the process."

The federal government should provide incentives for pharmaceutical companies and device makers to produce products that help cut spending and ensure that the benefits of costlier advances justify their added expense, according to a new Rand Corp. report.

"We spend more than $2 trillion a year on healthcare in the U.S.--more per capita than any other nation--and the financial incentives for innovators, investors, physicians, hospitals and patients often lead to decisions that increase spending with little payback in terms of health improvement," Steven Garber, a Rand senior economist and principal investigator of the study, says in an announcement.

The Royal College of Physicians would like structured letters to be created from structured records. That isn’t going to happen for a while yet, but digital dictation specialists are helping trusts and GPs to start moving in that direction. Fiona Barr reports.

Outpatient letters and discharge summaries created as structured documents from structured records are a tantalising prospect for the health service.

It is an idea that was set out by the Royal College of Physicians in its ‘Future Hospital’ report last year; and one that is likely to be welcomed with open arms by GPs.

It would mark a big change with the reality today; which is that outpatient letters are often unstructured, free text documents with large variations in content both between individual clinicians and within and between departments and hospitals.

A startup called BaseHealth launched on Tuesday with a mission to deliver personalized wellness plans while keeping doctors very much in the picture. The company’s platform combines genetic data, lifestyle data and medical records to determine patients’ risks and how they can mitigate them.

Promising to reinvent preventative medicine by bringing genomic data, medical research and connected devices together in a single platform, a startup called BaseHealth launched on Tuesday. The company, which has raised $6.3 million from a group of investors led by RONA Holdings and Bobby Yazdani, hopes a personalized and predictive approach to will help patients identify their prospective problems and then take the right steps to prevent them.

About 40 percent of providers shopping for a new electronic health record system during the first quarter of 2014 were seeking a replacement for their current EHR, according to a survey from EHR reviewer Software Advice.

The percent of prospective buyers looking for a replacement EHR has grown 30 percent since the first quarter of 2013.

Going beyond health information exchange as a replacement for the fax machine, Children's Hospital of Philadelphia and Virtua, a Southern New Jersey health system, have unified their radiology operations across electronic health records systems and state lines.

By deeply integrating imaging systems and EHRs, the two systems have made it possible to create an integrated health record that includes images captured at a Virtua facility and read by pediatric diagnostic imaging specialists at the Children's Hospital of Philadelphia. Even though CHOP, as it's known for short, is an Epic shop, and Virtua uses EHR software from Siemens, patient records are then synchronized across the two systems, with access to radiology reports and diagnostic images available from either one.

A group ranging from healthcare payers to medical centers participated in a series of exercises that simulated real cyber attacks on healthcare organizations, to see how well they could hold up under such an event.

The simulated attacks, called CyberRx, were conducted in partnership with HITRUST, the U.S. Department of Health and Human Services.

The Health and Social Care Information centre has admitted to repeated data breaches involving the Hospital Episode Statistics.

Documents obtained by MedConfidential in response to a Freedom of Information Act request say the HSCIC has records of one data breach for every year between 2009 and 2012.

The pressure group says it submitted the request after NHS England’s director of patients and information, Tim Kelsey, told Radio 4’s Today programme that use of HES was covered by such strict rules that “in 25 years, there has never been a single episode in which the rules... have ever compromised a patient’s privacy.”

April 22, 2014 -- A health information exchange (HIE) tool in electronic health record (EHR) software can help avoid a significant number of diagnostic tests and procedures, according to researchers from Allina Health.

In a study published in the current issue of Applied Clinical Informatics (Vol. 5:2, pp. 388-401), a team led by Tamara Winden of Allina Health found that the Care Everywhere tool in their Excellian EHR software (Epic Systems) avoided 560 potentially duplicative diagnostic procedures, such as blood work and medical imaging exams, over a six-month period at four emergency departments (EDs).

Seems like the sky is the limit for cloud computing, whether it is to replace servers, manage mobile apps or handle system recovery. Cloud vendors are constantly coming up with new ways to utilize a platform that seemed like little more than vapor five years ago.

It was just that long ago that Alex Brown, CEO of Chicago-based 10th Magnitude, saw the cloud’s potential and became an evangelical about it. He concedes it was a tough sell at first.

“Initially people were skeptical and there were a lot of barriers,” he said. “It was hard getting traction with it – no one budged. But eventually small and mid-sized organizations realized they could reach their visions with the cloud because its affordability allowed them to finally compete with the big guys. Initially, they were our market.”

What's vital for 2014 on National Coordinator for Health IT Karen DeSalvo's agenda?

Privacy and security, she told HealthcareInfoSecurity in a recent interview.

"We consider privacy and security an important part of the work that we do," DeSalvo said. "It's increasingly complex as we think through care models, mobile health, e-health, telehealth and the broader issues of big data and how we make certain that people's health information is first and foremost there to improve their care wherever they are ... but, as they desire, is also available [for research] to help advance the health system and population health overall."

Seeking a way to confront a "quiet cacophony" of beeping, alarming bedside monitors, Boston Children's Hospital has tapped into predictive analytics to forecast changes in patients' conditions before alarms sound.

The Boston Globereports that the hospital joined forces with a startup to analyze the data monitors put out, like vital signs or respiratory rates, and assess whether the patient's condition is at risk of getting worse.

"There are so many pieces of data coming at the physician. With almost 30 ICU patients, we're just inundated," Joshua Salvin, a pediatric cardiologist at Boston Children's, told the Boston Globe. "If we had something that could tell us where the hot spots are on the floor, we could direct resources to the most sick patients."

Diabetes afflicts more than 22 million Americans, or 7 percent of the total population, and the number of people diagnosed every year is skyrocketing.

At a cost of $245 billion in 2012, the disease’s toll on the economy has increased by more than 40 percent since 2007, according to a recent report from the American Diabetes Association.

Mississippi, which ranks second after West Virginia in the percentage of residents affected by the chronic disease, is taking steps to reduce devastating effects on the state economy and the overall health of Mississippians. Nearly 9 percent of Mississippians were diagnosed in 2012 with diabetes, and the $2.7 billion annual cost of diabetes represents nearly 3 percent of the state’s economy (gross state product).

Everyone knows how to stay healthy – eat less, move more. It’s actually making those changes to daily life that is the hard part.
The same is not true for people living with diabetes or heart failure or kidney trouble. Treatment plans are complex and often hard to remember, particularly if you’re not feeling well.

Launched at the end of February, the app takes complex treatment plans and makes them digital. It offers patients and providers tools to ensure that care plans are followed, including medication reminders and vital sign tracking, such as blood pressure.

A report recently released by JASON, an independent group of science and technology experts that often advises the federal government, calls on HHS to use meaningful use stage 3 to promote a standardized, national health IT architecture that would be a significant step toward interoperability.

"The criteria for stage 1 and stage 2 meaningful use, while surpassing the 2013 goals set forth by HHS for electronic health record adoption, fall short of achieving meaningful use in any practical sense," according to the report. HHS has the opportunity with meaningful use stage 3 to un-silo data with national standards that would foster data exchange for the national improvement of healthcare.

The federal government continued to implement the Health Information Technology for Economic and Clinical Health Act, enacted as part of the American Recovery and Reinvestment Act, during the first quarter of 2014.

Highlights

The first quarter of 2014 saw a number of important developments:

Final Rule Gives Patients Right to Access Laboratory Test Results. On Feb. 6, CMS, CDC and the Office for Civil Rights jointly issued a final rule that gives patients direct access to their laboratory test results. The final rule amends both the HIPAA Privacy Rule and the Clinical Laboratory Improvement Amendments of 1988 regulations.

HHS Strategic Plan Highlights Meaningful Use. On March 14, HHS released its five-year strategic plan for 2014 through 2018. The plan includes performance goals related to meaningful use, including increasing the number of primary care physicians that use electronic health records. The plan also identifies strategies to advance EHRs, such as using incentives, certification and grants to help increase EHR adoption.

ONC Releases Proposed Rule on 2015 EHR Certification Criteria. On Feb. 26, the Office of the National Coordinator for Health Information Technology, released a proposed rule that would specify the voluntary certification criteria that EHR developers and providers qualifying for the Medicare and Medicaid EHR Incentive Programs may adopt starting in 2015. The 2015 criteria would clarify, update and add to the 2014 criteria and simplify the certification of certain EHR modules. The 2015 criteria proposed in the rule would be voluntary. No EHR technology developer that has certified its EHR technology to the 2014 Edition would need to recertify to the 2015 Edition in order for its customers to participate in the EHR Incentive Programs. Furthermore, eligible professionals, eligible hospitals and critical access hospitals would not need to upgrade to EHR technology certified to the 2015 Edition in order to have EHR technology that meets the Certified EHR Technology definition. The proposed rule introduces the beginning of ONC's more frequent approach to health IT certification regulations. Under this approach, ONC intends to update certification criteria editions every 12 to 18 months in order to provide smaller, more incremental regulatory changes and policy proposals.

Risk calculators for cardiovascular disease (CVD; conditions that affect the heart and blood vessels) are nothing new – the Framingham risk calculator has been available for years. But the new JBS3 has many benefits:

Easily accessible online.

Provides what is considered an accurate risk estimation of experiencing a serious CVD event such as a heart attack or stroke.

Is of use to younger adults who could be on the route to a stroke or heart attack due to unhealthy lifestyle choices, even if short-term risk is low.

The calculator includes ‘heart age’ estimates and predicts the years they can be expected to enjoy without developing CVD. It also shows the benefits that people would experience if they made changes to their lifestyle such as stopping smoking or reducing blood pressure or cholesterol levels. The ultimate aim is to empower people to reduce their risk of CVD.

ParkinsonNet is a dedicated website that links Dutch Parkinson’s disease sufferers with doctors and nurses who specialize in that disease area. It behaves like a Facebook for Parkinson’s patients. The professionals communicate and collaborate on the website, a place where patients can locate information about treatment, about the professionals themselves and what they do. If required, they can also request an at-home consultation via video link.

Since it was introduced in 2004, ParkinsonNet has expanded into 66 regional networks and links nearly 3000 professionals from 15 different disciplines to Parkinson’s patients all over The Netherlands.

Evidence presented by the researchers, from the Radboud University Medical Centre, suggests that the website ‘empowers patients, improves the quality of care, shifts care away from institutions and into the community and lowers healthcare costs’. The researchers concluded that the model could be successfully transferred to patients with other long-term conditions such as diabetes and breathing problems.